The Maryland UNO-CAP project is a public-academic liaison (PAL) that includes the Johns Hopkins University (JHU) Center for Child and Adolescent Mental Health Services Research; the Governor's Office of Children, Youth, and Families other State and City agencies serving children; and Yale University. The project employs an accelerated cohort design to collect data, and a developmental and ecological perspective to describe (1) the types and patterns of mental health services delivered to children and adolescents ages 4 to 17, (2) the extent and types of unmet need for services; and,(3) the factors affecting access to, use of, and outcomes of mental health services. In order to more clearly understand the use of different types of services, a major focus will be on methods for defining need that best reflect the patterns of care and outcomes of various groups, using such definitions as DSM-IV diagnostic criteria, the Center for Mental Health Services' definition of "serious emotional disturbance," and definitions of need based on the latent structure of symptoms and characteristics of the child, family, and environment. In monitoring the outcomes associated with mental health services, we also are interested in alternative measures of outcome such as stability of living situation and symptoms, and the effects of service use on the course of emotional and behavioral disorders in children. The proposed study contains five components: (1) a community household survey of children ages 4-17 living in four of the seven mental health service catchment areas in Baltimore, (2) a survey of children in residential settings not included in the household sampling frame, (3) a survey of new admissions to health and human service agencies and residential settings, (4) a survey of providers of mental health services and policy makers, and (5) three and six month telephone follow-up interviews and in person interviews at one and two years after baseline for children enrolled in components 1&3. We will assess need by interviewing children, parents (or parent surrogate), and teachers, and we will obtain records from schools and service providers. The study will yield age and gender specific estimates of need for mental health services and will monitor changes in the need for services. In addition, it will test specific hypotheses about variations in need, services use, natural and treated course of disorders and outcomes.